Coming home from hospital: the first two weeks

Discharge day feels like the finish line. It is closer to the starting line.

For two weeks the ward has run everything. Meals arrived, medications appeared at the right hour, and somebody looked in overnight. Then all of that stops in a single afternoon, and the person doing the looking in is a daughter who works full time.

This is general information about a common situation, not medical advice. Anything about medication, wounds or symptoms belongs with the treating team and the GP.

The first forty-eight hours

Most of what goes wrong in the fortnight goes wrong here, and almost all of it is logistical rather than medical.

Get through the front door properly. Whatever was hard before is harder now. The back step, the hall runner, the bathroom. Our home safety checklist is a fifteen minute walk-through and it is worth doing before the car pulls up, not after.

Sort the medications on day one. Discharge almost always changes something, and the dangerous version is the old packet and the new script both sitting in the kitchen. Take the discharge summary to the pharmacy and the GP and let them reconcile it.

Book the follow-up appointments before anything else. GP within the first week is the usual expectation. Make the calls while somebody capable is still in the house, because in four days it will not happen.

Fill the fridge. Appetite is usually poor and cooking is usually beyond them. Simple food that needs nothing done to it.

Agree who is checking in, and when. Not “we will all keep an eye out”. A named person on a named day. Vagueness here is how the second week goes quiet.

Week one: keep it small

The goal of the first week is not recovery. It is not going back.

Expect much less energy than anyone predicted, including the person themselves. Expect sleep to be broken, because a fortnight of ward nights does that. Expect confidence to be lower than function, which is the part families miss. Someone who can manage the shower may still be frightened of it, and fear keeps people in the chair, where they get weaker.

What helps in week one is short and boring. Up and dressed each day. Something to eat at roughly the usual times. A short walk to the letterbox rather than a big outing. One visitor a day rather than the whole family at once on Saturday.

If showering is the sticking point, that is the most common reason people bring in help for a few weeks, and it is often temporary. Our guide on personal care done with dignity covers what that actually looks like.

What sends people back

Worth knowing so you can watch for it, and worth ringing the GP or the hospital about rather than waiting for the next appointment.

• A fall, or a near miss that frightened them
• Medication confusion, doubled doses, or doses missed for days
• Not eating or not drinking properly for more than a day or two
• New confusion, or a marked change in how alert they are
• Any wound or site that looks worse rather than better
• Pain that is not controlled by what they were sent home with

The ordinary version of a setback is not dramatic. It is somebody quietly staying in bed, eating nothing much, and telling everyone on the phone that they are fine.

Week two: rebuild the ordinary

Week two is where the thing to protect is the routine, not the rest.

Get back to real clothes, real meals at real times, and the parts of the week that were theirs before. The shop. The Thursday phone call. Sitting outside. People recover faster inside a shape they recognise, and the piece on small things that keep independence is mostly about this.

This is also the week to be honest about what has actually changed. Some things come back in a month. Some do not come back, and pretending otherwise means the house stays set up for a version of the person who is no longer there.

Getting help in place, and paying for it

If there is already a Support at Home arrangement, ring the provider before discharge, not after. Support can often be increased quickly while any paperwork catches up.

If there is not, the hospital social worker or discharge planner is the fastest route, and they can start a My Aged Care referral before the person leaves the ward. Short-term restorative care is worth asking about specifically, because it is designed for exactly this and it is time limited. Start at myagedcare.gov.au or 1800 200 422, and our funding pillar explains how the pieces fit. Aged care costs are means tested and change, so get your own figures rather than an estimate from anyone.

Our post-hospital support page sets out what we do in this period, and the companion list, questions to ask before hospital discharge, is worth taking into the ward with you.

The part families underestimate

Somebody is going to absorb the first fortnight. Time off work, nights on the sofa, three trips a day. That person will say they are fine, and they will mean it for about ten days.

Put the smallest bit of paid help in early rather than as a rescue at week three. It is cheaper, it works better, and it keeps the family relationship from turning entirely into a roster. Our piece on how families share the load covers doing that without a falling out.

If a discharge is coming up and you want to talk it through, get in touch. A real person answers.